Africa is alarming. The aim of this prospective 4-year study was to evaluat
e the rising incidence of HIV-related admissions due to meningitis at the P
retoria Academic Hospital (PAH) adult neurology wa rd a nd to investigate t
he spectrum of meningitis during this time. Patients and
Methods: Adults with meningitis presenting at the PAH neurology ward from M
arch 1994 through February 1998 were included. HIV antibody status was dete
rmined and patients were assigned to five categories: bacterial, tuberculou
s, viral and cryptococcal meningitis, as well as an uncertain category.
Results: Over the 4-year study period 141 patients with meningitis were see
n. Of these, 44 were HIV-positive (31%), with TB meningitis occurring in 16
(36%), cryptococcal meningitis in 22 (50%) and acute bacterial meningitis
in th ree (7%) In the first 2 yea rs of the study, 14% of patients were HIV
positive; this figure rose to 44% in the 3rd year, and 57% in the final ye
ar. The spectrum of meningitis also changed: bacterial meningitis remained
relatively stable at about 25% of the total; TB meningitis almost doubled f
rom 16% in the Ist year to 31% in the last year of the study; viral meningi
tis initially occurred in 8% of patients and later in 3% of cases, while cr
yptococcal meningitis showed the most significant increase from 6% of cases
in 1994/5 to 31 and 26% respectively in the last 2 years of the study.
Conclusion: Over a 4-year period the HIV epidemic was responsible for a mar
ked shift in the spectrum of meningitis towards chronic infections such as
TB and cryptococcal meningitis at the PAH.